Imaging Methods Used in The Diagnosis of Gastrointestinal Perforation and Imaging Findings

Abstract

Purpose: To evaluate the imaging methods used in patients diagnosed with gastrointestinal perforation (GIP) and the contribution of these methods to the diagnosis.
 Methods: Preoperative radiological examinations of 73 patients 18 years old or older whose surgical results indicated GIP were retrospectively evaluated. The perforation sites were divided into 4 groups, namely the first segment of the gastroduodenum, part of the small intestine beginning with the second segment of the duodenum, the colorectum, and the appendix. Esophageal perforations were considered as a separate group and excluded from the study. 
 Findings: Fifty-two (71.2%) of the patients were male. The mean age of the patients was 45.1±18.2 years with a range of 18-87 years. Forty (54.8%) patients had perforations of the appendix and 25 (34.2%) patients had perforations of the gastroduodenum. Computed tomography (CT) was performed in 56 (76.7%) of the patients, ultrasonography (USG) in 55 (75.3%), and radiography (RG) in 48 (65.8%). The evaluation of RG images of the patients for the presence of subdiaphragmatic free air showed that 50% of the patients with non-appendix perforations had subdiaphragmatic free air. The most common findings in the USG results of the patients with appendix perforations were an increase in the diameter and heterogeneity of mesenteric fatty tissue, while the most common USG finding in the patients with the other perforations was free fluid. The site of perforation was accurately determined in 83.9% of the patients diagnosed with non-appendix perforations by CT. 
 
 Conclusion: CT is the most preferred imaging modality and has the most diagnostic value in the diagnosis of GIP. It is also useful in determining the perforation site.